Trauma To Permanent Teeth

My daughter was accidentally hit in the mouth with a hockey stick, which bruised her lower lip. It also appeared to slightly tear the piece of flesh attached to the gums between the upper front teeth and the lip. Bleeding was minor. My wife is concerned about damage to the two permanent front teeth which are just coming through. She is most worried about the teeth dying.

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Ouch! I hope your daughter is feeling better. Hopefully, you or your wife took her to the dentist for a thorough exam of the area to determine the extent of the trauma. During the exam, the dentist should assess both hard and soft tissues. It sounds as if the frenum (the soft tissue attachment you describe) was torn. This will most likely heal and reattach, especially if the tear was incomplete. The condition of the teeth and attached bone should be examined for any possible fractures. In addition, some simple vitality tests should be performed on the teeth in question, even if they appear to be fine. This will establish baseline measurements to enable the dentist to properly assess any future changes which may occur.

One of these tests may include transillumination. This involves shining a small, strong fiberoptic light through the tooth. This procedure can help detect the presence of cracks or fracture lines and can show subtle changes in the color of the injured teeth. In fact, if the injured teeth appear darker than unaffected teeth at the time of injury, this is an indication of pulpal (nerve and blood vessels within teeth) hyperemia. These teeth do have a poorer prognosis for maintaining vitality than do teeth which are not darkened as a result of injury. However, if the root apex is not closed (which may be the case with your daughter, especially if her permanent teeth are not fully erupted), the prognosis is slightly better than a tooth with a closed apex. If a tooth does change color, which can be several weeks to months after the accident, it is likely the tooth has lost its vitality. A root canal or extraction is required for permanent teeth that have died.

Other tests at the time of injury should include response to percussion (tapping on the tooth), palpation, thermal testing, and radiographs. Percussion can help give information about the extent of injury to the apical tissues. While it is not unusual for a recently traumatized tooth to be sensitive to percussion, teeth which do not have sensitivity to percussion have a better prognosis. Sound is also important when the tooth is percussed. If the sound is dull compared to non-injured teeth, this may indicate tooth displacement. A metallic, hard sound may indicate ankylosis (fusion of the tooth to the bone).

Several radiographs may need to be taken to determine if root fractures exist. Different angles may also reveal an immediate loss in pulpal vitality. Follow-up exams and radiographs are extremely important as changes may occur several weeks, months, or even years later. Radiographs, transillumination, and percussion may be the best indicators of future vitality loss. Responses and prognoses are so variable, it is difficult to predict how your daughter's teeth will react in the future. If your daughter participates in sports, I recommend that she wear an athletic mouthguard.

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